Spine surgery increased substantially in the U.S. during the past three decades, particularly in the elderly. Wound complications after spinal surgery can be associated with significant morbidity, including serious neurologic deficit, vertebral instability, and death. CDC estimates 300,000 surgical site infections occur annually in the U.S. The elderly are at increased risk for surgical site infections and have a 5-fold higher risk of death and 2-fold higher hospital costs associated with infection. Many states have recently enacted legislation mandating public reporting of surgical site infections, and a new CMS rule eliminates increased hospital payment for surgical site infections following some surgeries. It is unclear how many of these infections are potentially preventable. There are no nationally representative data on variation in infection rates and no established methods to risk-stratify surgical site infection rates, adjusting for differences in patient mix and type and complexity of surgery. There is marked variability (<1- 15%) in reported spinal surgical site infection rates from individual institutions. Despite this variability, there are little data on risk of surgical site infection and noninfectious wound complications after spine surgery analyzed by specific surgeon or hospital characteristics.
The aims of this proposal are to use Medicare claims data for spine surgery performed in elderly persons from 2000-2005 to determine: 1a) the incidence of postoperative surgical site infection and noninfectious wound complications, b) clinical outcomes of these complications, including hospital readmission, repeat surgery, and mortality, c) variation in the ratio of infectious to noninfectious wound complications by surgeon and hospital, and 2) risk factors for surgical site infection and noninfectious wound complications at multiple levels, including patient-level (age, type and reason for surgery, co-morbidities, previous infections, and severity of illness), surgeon-level (time in practice, specialty, and surgery volume), and hospital-level (hospital size, teaching status, surgery volume, and region of the country). The results of these studies will guide future research to improve processes of surgical care and inform health care policy regarding public reporting of infections, with the goal to reduce disability and improve quality of life for the elderly undergoing spine surgery. Public Health Relevance: The goals of this study are to determine if the occurrence of wound infections and other wound complications after spine surgery varies across surgeons and across hospitals, and to determine patient, surgeon, and hospital factors associated with increased risk of these complications in elderly persons. The results of this study will ultimately be used to improve the quality of care provided to spine surgery patients.
The goals of this study are to determine if the occurrence of wound infections and other wound complications after spine surgery varies across surgeons and across hospitals, and to determine patient, surgeon, and hospital factors associated with increased risk of these complications in elderly persons. The results of this study will ultimately be used to improve the quality of care provided to spine surgery patients.
